NEW AND DEVELOPING MEDICAL SCHOOLS

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1 NEW AND DEVELOPING MEDICAL SCHOOLS Motivating Factors, Major Challenges, Planning Strategies Michael E. Whitcomb, M.D. Professorial Lecturer in Health Policy School of Public Health and Health Services George Washington University Josiah Macy, Jr. Foundation October 2009

2 Preface The first expansion of medical schools in this country in more than 20 years represents an important moment for medical education nationally. The Josiah Macy, Jr. Foundation took advantage of this moment to sponsor a conference in October 2008 entitled, Revisiting the Medical School Education Mission at a Time of Expansion. A conclusion of the conference, directed at the new schools as well as all existing schools, was: This period of expansion in enrollment must not result in more of the same. Failing to take full advantage of the opportunity afforded by this natural experiment to advance the mission of medical education for the benefit of the public would be tragic. A number of recommendations were made on ways to improve the educational programs of all medical schools to better align them with the needs of society. 1 That conference was not designed to address the how and the why of each of the new schools or the expansion plans of existing schools. The case studies reported in this report explore the motivations, challenges, and responses of ten emerging new schools. Unlike the last major medical school expansion, which occurred in the 1960s and 1970s, there is neither a federal mandate nor funding for this expansion. As a consequence, it is not surprising that each of the stories is quite different with unique local 1 Hager M, Russell S, editors. Revisiting the Medical School Educational Mission at a Time of Expansion. Proceedings of a Conference Sponsored by the Josiah Macy, Jr. Foundation; Charleston, South Carolina, in October Preface 3

3 drivers, diverse sources of funding, and a spectrum of aspirations and goals. Dr. Whitcomb is uniquely qualified to conduct this study because of his broad experience as a medical educator and administrator. His interviews and travels have enabled him to identify emerging trends that reflect the impact that changes in the delivery system, in the profession, and in academic structure have had on the new schools. These trends may be important harbingers of more changes to come. The importance of healthcare systems as partners or sponsors of new medical schools is one of these emerging trends. Another is the further evolution of two-year branch campuses of existing schools into full four-year programs, perhaps anticipating their becoming new freestanding schools. There are also differences in the departmental structure of new schools that have not necessarily replicated all of the traditional medical school departments. Furthermore, lessons may be learned from the rapidly expanding osteopathic schools, which have been innovative and flexible in their educational models. This report represents a significant historical document for an important moment in the evolution of medical education in this country. But more than that, it should be a stimulus for broader discussions about the future of medical education. There is a great need for us to be working on educational innovations that produce a medical profession appropriate in numbers, skills, interests, and distribution to meet the needs of a changing society and a changing healthcare delivery system. This is an important contribution to that discussion. George E. Thibault, M.D. President, Josiah Macy, Jr. Foundation Prologue In 2000, the Governor of the State of Florida signed legislation authorizing Florida State University (FSU) to establish a new medical school. By the Fall of 2008, ten additional institutions had announced their intent to develop a new school. Review of the initiatives undertaken by those institutions makes it clear that the development of a new medical school is a costly undertaking that can take years to complete. An institution that is intent on establishing a new school will almost certainly face a number of unexpected challenges during the course of the planning process, which may result in significant delays in the opening of the school, or even lead the institution to decide not to proceed. It seems clear that those who might become involved in future efforts to develop a medical school would benefit from gaining an understanding of how those currently involved addressed the challenges they faced. The lessons to be learned should have value for university administrators, trustees, and state and local government officials who might become involved at some time in the future in discussions about starting a new medical school. The Josiah Macy, Jr. Foundation, in keeping with its mission to enhance education in the health professions, commissioned a study to address three important questions related to the establishment of the new medical schools under development in the United States: 4 Preface Prologue 5

4 What factors motivated the institutions to decide to explore establishing a new medical school? What major challenges did they confront during the process? How did they respond to those challenges? new school. In each case, the sequence of events leading to the point at which the institution received approval to proceed with the development of a school is described in some detail because that history provides insight into the early challenges the institutions encountered along the way, and how they dealt with them. The study was limited to the establishment of allopathic medical schools. Thus, when the term medical school appears in the text, it refers to an allopathic school unless otherwise indicated. To be clear, the purpose of the study was not to explore the nature of the educational programs developed by the schools, or to document events that unfolded after students were enrolled. Rather, its aim was to address the questions outlined above. It is particularly fitting for the Macy Foundation to have commissioned the study because they played an important role in documenting the development of new schools during the 1960s and 1970s the last period that witnessed a substantial increase in the number of medical schools in the United States. When the Governor of Florida signed the legislation authorizing FSU to establish a medical school, I was serving as the Senior Vice President for Medical Education at the Association of American Medical Colleges (AAMC). In that capacity I was able to follow closely the development of the FSU College of Medicine, as well as efforts underway by other institutions to start a new medical school. When I retired from my position at the AAMC in June 2006, several institutions asked me to assist them in their efforts. I had the opportunity, therefore, to witness firsthand the challenges they faced as they proceeded. In the years that followed, I was asked to provide assistance to a handful of other institutions that were exploring the possibility of starting a new school. Thus, when I began work on the project that led to this report, I had a great deal of personal experience with the initiatives underway. The information presented here was obtained through interviews of key individuals involved in the initial planning of each of the schools under development (university presidents, chancellors, provosts, and other senior administrators); review of documents relevant to those planning processes; and interviews with the founding deans and others responsible for guiding the schools through the implementation phase of the planning process. The case studies that appear in this report are presented roughly in the order in which the institutions first indicated their intent to establish a 6 Prologue Prologue 7

5 Introduction During the period from 1960 to 1980, 40 new medical schools were established in the United States, resulting in an almost 50 percent increase in the total number of schools in the country. The development of the new schools was largely a response to the widely held view that the country was facing a major shortage of physicians, which could only be avoided by increasing significantly the number of students graduating from the nation s medical schools. In 1963, the U.S Congress passed the Health Professions Educational Assistance Act to support this effort. That legislation was the first in a series of health manpower bills Congress passed during the 1960s and 1970s that provided federal funding to assist in the development of new medical schools and the expansion of enrollment in existing schools. The federal programs that were established in that era were responsible to a great extent, but not entirely, for the marked increase in the number of students graduating from medical school between 1960 and During that 25-year period, the number of graduates increased from approximately 7,500 to more than 16,000. Although the development of new medical schools did not end until the late 1970s, the rate at which new schools were being established decreased considerably in the early 1970s, for two major reasons: First, most of the states that had planned to establish a new medical school often the first medical school to be established in the state had done so by the early 1970s. And second, many of those interested in starting a new school recognized by the early 1970s that federal support for medical school expansion would not continue much longer because influential congressional leaders had already become concerned that continued growth in medical school enrollments would actually lead to a physician surplus. In 1976, the Graduate Medical Education National Advisory Committee (GMENAC) was established as a body charged by Congress to conduct an analysis of the state of the country s physician workforce. The development of GMENAC sent a clear signal that federal funding had run its course. Only three new medical schools were established after 1976, and none were established after GMENAC concluded in its 1980 report that the existing level of medical school enrollment would lead to a significant oversupply of physicians in the coming decades. The period of medical school expansion that began in 1960 had come to an end. Indeed, no new medical schools were established in this country during the next two decades (1980s and 1990s). Several institutions that considered starting a new medical school during the 1990s were unable to do so because state and local officials who had to approve the establishment of the schools perceived that the schools were not needed. This was due in part to the fact that the Council on Graduate Medical Education (COGME), a body established by Congress in 1986 to provide advice on physician workforce issues, began in the early 1990s to issue reports reinforcing the view that the country would have a large surplus of physicians by the year A policy statement issued by six major professional organizations, including the AAMC, in the mid- 1990s supported this position. In addition, the Pew Health Professions Commission, a privately funded body convened to study the state of the physician workforce, proposed in the mid-1990s that medical school enrollments be decreased by one fourth, primarily by closing existing schools. Nevertheless, as stated in the Prologue to this report, in 2000, the Governor of Florida signed legislation authorizing FSU, a public university located in the state s capital (Tallahassee), to establish a new medical school. Since that time, ten institutions have announced publically their intent to start new schools; a handful of others have explored the possibility of doing so and decided not to proceed (University of Houston, Idaho State University, George Mason University, and St. Thomas University); and others continue to consider the possibility. 8 Introduction Introduction 9

6 These ten institutions vary in a number of ways. Five of the institutions are private, and five are public. Four of the public institutions (University of Central Florida; Florida International University; the University of California, Riverside; and the Texas Tech University Health Sciences Center) are located in states where the establishment of a new medical school requires review and approval by a state authority (higher education body and/or legislature). Three of the proposed schools (Virginia Tech Carilion School of Medicine in Roanoke, Virginia; the Oakland University William Beaumont School of Medicine in a community outside Detroit, Michigan; and the Hofstra University School of Medicine, in partnership with the North Shore Long Island Jewish Health System) are being established as partnerships between a comprehensive university and a major healthcare system. One of the new schools The Commonwealth Medical College of Pennsylvania is a free-standing private institution that is not embedded within an existing university. The two remaining institutions on record as intending to start a new medical school The Scripps Research Institute in San Diego, California and Touro College in Manhattan, New York are private institutions that have degree-granting authority, although they are not traditional universities. Nine of the institutions have formally notified the Liaison Committee on Medical Education (LCME), the body that accredits the undergraduate medical education program conducted by medical schools, of their intent, and the tenth intends to do so in the near future. At present, five of the institutions have been granted preliminary accreditation status by the LCME. Four (University of Central Florida School of Medicine, Florida International University School of Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, and The Commonwealth Medical College of Pennsylvania) enrolled their charter classes in the summer of The fifth, the Virginia Tech Carilion School of Medicine, which was granted preliminary accreditation in June 2009, will enroll its charter class in Summer Three of the institutions are still actively involved in the initial planning process for the development of a school and have not yet submitted to the LCME the materials required to begin the formal accreditation process (Oakland University William Beaumont School of Medicine; Hofstra University School of Medicine, in partnership with North Shore Long Island Jewish Health System; and the University of California, Riverside, School of Medicine). As a result, the earliest those institutions will be able to enroll students will be Summer The two remaining institutions (The Scripps Research Institute and Touro College) have suspended their planning for the time being. Four major challenges exist for officials at institutions that hope to establish a new medical school. First, those leading the effort must be able to convince various stakeholders university faculty, university trustees, community leaders, and government officials of the value of establishing the school, and they must gain the support necessary to do so. Second, they must be able to obtain the funds required to cover the costs of the initial planning process and the actions required to prepare for implementation of the school s education program, primarily the recruitment of administrative staff and faculty. Third, they must develop a realistic plan for meeting the school s administrative and instructional space needs, including how funds will be obtained to cover the costs of any facility renovation or new construction that will be required. And fourth, they must be able to enter into clinical affiliation arrangements with various healthcare organizations to ensure the school s ability to provide appropriate clinical education experiences for its students. In essence, these four challenges must be met if an institution is to develop an undergraduate medical education program that will meet the standards required by the LCME for accreditation purposes. Once institutional leaders are convinced that they will be able to meet the challenges, they are then in a position to begin to actively plan for the opening of the school. To accomplish this objective, they must recruit a founding dean who will be able to lead the effort required to convince the LCME that the institution is prepared to conduct the first two years of the school s education program. Once the LCME grants preliminary accreditation, the school can begin to recruit students for the charter class. It is important also to recognize that the tradition of allopathic medicine creates an expectation that a medical school will offer more than an undergraduate medical education program. An allopathic medical school is also expected to do the following: 1) to provide an environment that encourages and supports the conduct of biomedical and health services research by its faculty; 2) to serve as the core of an academic health sciences center that offers a range of academic programs in other health professions; and 3) to create opportunities for clinical care programs that will serve the needs of the local community or region and provide a framework 10 Introduction Introduction 11

7 for the clinical education experiences required by the education program. Thus, in addition to meeting the four major challenges of an undergraduate medical education program (as discussed previously), institutions wishing to establish a new medical school also face the challenge of deciding how the new school will pursue its missions for research and clinical care. In addition to the ongoing development of the new medical schools, this decade has also witnessed the development of an entirely new model for medical school education: the establishment by an existing medical school of a full four-year undergraduate medical education program at a regional campus site (herein referred to as a branch campus). A large number of medical schools have for many years offered portions of their curricula at regional campus sites. However, the new branch campuses differ from these regional sites in an important way. The branch campuses will incorporate an entire undergraduate medical education program. Also, several of the branch campuses offer a curriculum that differs from that of the main campus (i.e., a separate track program). To date, six allopathic medical schools have enrolled students at branch campuses. Three of the branch campuses were established as collaborative efforts involving two separate institutions (the University of Miami Miller School of Medicine at Florida Atlantic University; the University of Arizona College of Medicine at Phoenix, in partnership with Arizona State University; and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University). The three other branch campuses have been developed within the organizational structure of a single university (Mercer University College of Medicine in Savannah, Michigan State University College of Human Medicine in Grand Rapids, and the University of Oklahoma School of Community Medicine in Tulsa). A number of additional branch campus sites are under development. The Medical College of Georgia has announced that it will enroll students at a new branch campus of the University of Georgia in Athens in Although the branch campus operates under the jurisdiction of the medical school administration, its educational program is conducted almost in its entirety by a separate faculty, and a separate administrative staff handles day-to-day management. In addition, the leadership of the branch campus has direct relationships with the leadership of local institutions that do not relate in a similar fashion with the leadership of the parent medical school. Thus, in a very real sense, the branch campus operates on a day-to-day basis as if it were an independent school. This situation exists because in most cases the branch campus site is some distance from the main campus of the medical school. The development of a branch campus is certainly less challenging than the development of an independent medical school because the main campus can commit existing staff and resources to the effort and retain designated administrative responsibilities, such as student admissions. Also, because branch campuses usually begin with a relatively small student body, provision of adequate space for administration and instruction is less burdensome. There is also no question that a branch campus can more easily transition to an independent medical school than an independent medical school can be developed on its own. Consequently, it is not surprising that several branch campuses are already considering the possibility of becoming independent medical schools. Indeed, at least one of the branch campuses was established with a tacit understanding that it would become independent at some time in the future. Therefore, it is logical to include information related to the development of branch campuses in this report, including case studies of branch campuses that have already enrolled students. These examples provide insight into the factors that were involved in the development of the branch campuses and the complex challenges faced by the institutions involved in establishing them (medical schools and universities). The events that unfolded during the process of planning each of the new schools are described in the case studies that follow. In each case, the description of the events leading to each school s current status focuses on how the institution met the major challenges it faced along the way. The early history of each school s development is presented in detail because it is during that period that institutions encountered several of the major challenges they had to overcome in order to proceed. The first three case studies focus on the development of new medical schools in Florida, each of which was affected by changes that occurred in the early years of the decade in the way the state reacted to proposals for starting new schools. 12 Introduction Introduction 13

8 University of Florida to expand the PIMS into a two-year or four-year medical education program. Given the University of Florida s unwillingness to expand the program, it is not surprising that FSU would ultimately take steps to establish its own medical school. Case Studies Independent Medical Schools Florida State University College of Medicine Florida State University (FSU) is a public institution located in the state s capital (Tallahassee). The university offers a wide range of undergraduate and graduate degree programs and has an enrollment of more than 40,000 students. Using the classification system developed by the Carnegie Foundation (Carnegie Classification for Institutions of Higher Education), FSU is classified as a Research University (very high research activity). The new FSU College of Medicine, which was authorized by the Legislature and the Governor in 2000, enrolled its charter class in 2001, to graduate in In some respects, the development of the medical school at FSU is a natural evolution of the university s involvement in medical education. In 1970, FSU reached an agreement with the University of Florida College of Medicine that allowed FSU to provide the first year of the curriculum on its campus. The new medical program, called the Program in Medical Science (PIMS), accepted only 30 students, and only students enrolled as undergraduates at FSU, Florida A&M University, and the University of West Florida were eligible to apply for admission. The development of the FSU College of Medicine was to a great extent the direct result of efforts that the university had made during the 1990s to gain approval from the FSU s efforts to expand the PIMS began in 1991 when the university initiated a review to determine why students who had completed the program performed less well on Step 1 of the medical licensing examination (USMLE) than did other students enrolled in the University of Florida College of Medicine. After completing the review, university officials attributed the high failure rate to the fact that the students applying to the program from FSU, Florida A&M, and West Florida were not as strong academically as the students applying directly to the University of Florida College of Medicine. As a result, the policy governing admission to the PIMS was changed in 1992 so that any Florida resident could apply no matter where they were enrolled as undergraduates. Equally important, the PIMS review process convinced FSU officials that the university could offer a full four-year medical education program. Accordingly, in 1993, the university sought approval from the University of Florida to establish a four-year track at FSU a request that the University of Florida denied. By 1997, several other state universities had indicated their interest in establishing a medical education program on their own campuses. Anticipating that the institutions would ultimately seek approval to establish new medical schools, the Chancellor for Higher Education, with support from the Board of Regents for the State University System, indicated that no new medical schools would be established in the state for at least ten years. The Chancellor did indicate, however, that he would be supportive of establishing additional PIMS-like programs at other universities. The Board of Regents ultimately approved the establishment of a PIMS-like program on the campuses of two state universities (Florida Atlantic University and the University of Central Florida). During that period, FSU sought approval to extend their PIMS to a two-year program. That request was not approved. Despite the Chancellor s position, members of the legislature had become concerned about the adequacy of the state s physician workforce and the ability of the state s medical schools to train an adequate number of new physicians. At the time, only three medical schools existed in 14 Case Studies Case Studies 15

9 the state the University of Miami, the University of Florida, and the University of South Florida and all three had been in existence since The legislature was especially concerned because, although Florida was at that time the country s fourth largest state in population and had the highest rate of population growth among large-population states, it ranked near the bottom among all states in the number of medical school positions available on a population basis. Although the number of physicians practicing in the state was near the average for all states, Florida ranked near the top in the percentage of practicing physicians who received their M.D. degrees from a non-u.s. medical school. Thus, the position taken by the Chancellor and the Board of Regents led to a mandate from the legislature to engage a consultant to evaluate the need for additional medical education programs in the state. In 1999, the consultant submitted a review to the Board of Regents and the state legislature. The report concluded that Florida did need additional medical schools to provide more opportunities for Florida residents to study medicine within the state, thereby increasing the supply of physicians likely to serve the needs of the state s population. In response, the Chancellor argued that state residents could be provided more opportunities to study medicine in the state if the existing medical schools increased their class sizes. He also pointed out that the supply of physicians for the state was determined by the size of the state s graduate medical education system, not by the number of medical schools in the state. Nevertheless, he did recommend that a study be conducted to determine the feasibility of establishing a new medical school in the state at some future time. However, based on the findings of the consultant report, key members of the legislature, who were aware that FSU had been denied the opportunity to expand the PIMS conducted on its campus to a two-year program, invited FSU to submit a proposal to establish an independent medical school. In working with the legislators, FSU developed a proposal to establish an innovative educational program that would help to meet several of the state s special needs, particularly the need to provide greater access to healthcare for individuals living in underserved regions of the state and to elderly patients in need of special geriatric care. A bill authorizing FSU to establish such a school was passed by the legislature and signed by the Governor in As a result of its longstanding involvement with the PIMS, the university was able to proceed quickly in establishing the new medical school because it already had the faculty and facilities required to conduct the first year of the curriculum. To accommodate the class size projected for full enrollment, the university constructed a new medical school building and a new biomedical research building in proximity to the medical school building. The cost of both buildings was covered by state-appropriated funds. In keeping with the original design concept for the curriculum approved by the legislature, the medical school established six regional clinical campuses across the state (Daytona Beach, Fort Pierce, Tallahassee, Pensacola, Orlando, and Sarasota) where students obtain clinical experiences that are largely ambulatory based. The school also established two sites in the Florida Panhandle to provide students with an opportunity to participate in a rural track. Florida International University College of Medicine Florida International University (FIU) is a public institution the main campus of which is located in a western suburb of Miami. Although FIU was established by the legislature in 1965, it did not begin to enroll freshman and sophomore students until 1981 and did not receive approval to start graduate programs until The university has grown; now it offers a large number of undergraduate and graduate degree programs and has an enrollment of more than 32,000 students. FIU is also one of only two state universities located in South Florida, a region with a very large and growing Latino population. FIU is classified as a Research University (high research activity). Interest in developing a medical school at FIU, which would provide opportunities for members of the growing immigrant population of South Florida to attend medical school, existed on the campus in the early 1990s. However, given the challenges inherent in developing a relatively young university, the university s leadership was initially not supportive of the idea of trying to start a new medical school. A report issued by the University s Strategic Planning Advisory Committee in the mid-1990s suggested the possibility of developing a medical school as a long-range strategic priority for the university. As a result, a Medical School Concept Committee was appointed in 1996 to develop a general approach for the establishment of a new school, and a White Paper proposing the 16 Case Studies Case Studies 17

10 development of a community-based school at FIU was submitted to the Chancellor for Higher Education in In July 1997, the State Chancellor met with officials from the University of Miami, FIU, and another relatively new university in South Florida, Florida Atlantic University, to discuss how the institutions might work together to address the growing interest in the establishment of medical education programs in South Florida. At the meeting, the Chancellor expressed support for the development of a PIMS-like program at Florida Atlantic University in partnership with the University of Miami. He also recommended that FIU develop a program in medical science with one of the other existing medical schools in the state, but FIU remained committed to the development of an independent medical school. When the legislature approved the development of the new FSU College of Medicine in 2000, FIU officials began once again to explore the possibility of establishing a new school. The university s internal planning effort was fostered in part by a series of significant changes that occurred in the state s approach for providing oversight and management of the State University System changes that had a dramatic impact on the approach for handling proposals for new medical schools. In 2001, the legislature abolished the Board of Regents, which had been opposed to the development of new medical schools. In 2003, a new body the Board of Governors was established to oversee and coordinate planning for the State University System. One of the first actions taken by this group was to ask the newly established Medical Education Subcommittee to study the need for additional schools in the state. Coincident with the establishment of the Board of Governors, FIU issued its 2003 Millennium Strategic Planning document, which set forth a vision for FIU as a top urban public research university. In the document, FIU indicated that establishing a medical school was an important step for achieving that goal. The two-year intensive study conducted by the Medical Education Subcommittee assessed the state s physician workforce needs and how those needs might best be met. Following the Subcommittee s first meeting in 2004, the Board of Governors requested the state s Council for Education Policy, Research and Improvement (CEPRI), an independent office that had been established by the legislature in 2001 to prepare a long-range master plan for education in the state, to conduct a Medical Education Needs Assessment. The CEPRI leadership appointed a Medical Education Study Advisory Committee, composed of leading medical educators and university administrators, to conduct the study and provide a report before the end of the year. During that year, the Board of Governors spent considerable time at each of its meetings examining issues related to medical school expansion. A number of local and national figures were invited to make presentations designed to educate the Board about the issues. The CEPRI Report, issued in November 2004, examined two major issues: the adequacy of the physician workforce and options for addressing a physician workforce shortage. To address the first of these two issues, the report recommended that the legislature establish a physician workforce database that would provide accurate statistics on the nature of the state s physician workforce; the CEPRI Report also asked policymakers to develop a model for determining the adequacy of the workforce based on the data produced. The Report also included recommendations for dealing with the shortage. The most important of those recommendations was that increases in medical school enrollments should only occur after expansion of the state s graduate medical education system because increases in the state s supply of physicians was dependent on increasing the number of graduate medical education positions available in the state. The authors of the Report also noted that establishing a new medical school was the most expensive approach for increasing the number of students graduating from the state s medical schools. Following the release of the report, the Council of Medical School Deans sent a letter to the Board of Governors reinforcing the CEPRI recommendations for the establishment of a reliable physician database and for expansion of the state s graduate medical education capacity. Despite these recommendations, officials from FIU and the University of Central Florida made presentations to the Board of Governors in January 2005 summarizing their planning efforts for new medical schools and their arguments for why they should be granted approval. Following a number of discussions at Board of Governors meetings, both universities submitted formal proposals to the Board in September 2005 seeking approval to establish new medical schools. In March 2006, after detailed analyses of the proposals and a special Board of Governors meeting devoted to an intense discussion of the proposals, the Board voted unanimously to approve the establishment of new medical schools at FIU and the 18 Case Studies Case Studies 19

11 University of Central Florida. The charter class (40 students) of the FIU College of Medicine began studies in August 2009 in a renovated space located in one of the university s health sciences buildings. The new school will not be able to reach its projected enrollment of 120 students until a new medical school building has been constructed. University of Central Florida College of Medicine The University of Central Florida (UCF) is a public institution whose main campus is located in Orlando. The university offers a large number of undergraduate and graduate degree programs and has a total enrollment of more than 50,000 students. The university is classified as a Research University (high research activity). In the late 1990s, when the Chancellor for Higher Education was defending his position that no new medical schools should be established within the State University System, he indicated that he anticipated receiving proposals for new medical schools from several of the state universities (Florida State University, FIU, and UCF). Again, the Chancellor encouraged them to explore the development of a PIMS-like program with one of the state s existing medical schools. UCF officials did enter into such an agreement with the University of South Florida, but the program was not funded by the state legislature. When the legislature approved the development of a new medical school at FSU in 2000, UCF officials began to consider establishing a new medical school on the UCF campus in Orlando. They believed that a medical school was a natural addition to their expanding portfolio of programs related to the health sciences and health professions education. Key community leaders, recognizing that Orlando was one of the largest metropolitan areas in the country without a medical school, fully supported the university s effort. In 2003, the UCF Board of Trustees encouraged the university leadership to explore the feasibility of establishing a new medical school at UCF. When the new Board of Governors Medical Education Subcommittee began its work in 2004, it was apparent that UCF would almost certainly submit a proposal for starting a new medical school in Orlando. In January 2005, UCF officials, working closely with FIU, made a presentation to the Board of Governors summarizing the status of their planning effort and explaining why they believed the Board of Governors should approve the development of a new school at UCF. Then in September 2005, once again in tandem with FIU, UCF submitted a formal proposal to the Board of Governors seeking approval to establish a new medical school. In March 2006, the Board approved that request. The planning process that ensued was quite intense. To meet its goal of enrolling students by 2009, UCF had to make a number of decisions related to key issues that had been identified during the planning process. Perhaps most important was the location of the medical school. It had generally been assumed that the school would be located on the university s main campus in suburban Orlando. However, during the early planning process, the university was presented with an opportunity to take the lead in developing a new academic medicine complex in Orlando by establishing the medical school on land to be donated at a major new development site (Lake Nona) about 15 miles from the university campus. Although this was an attractive option, it also presented problems, not the least of which was how the medical school would relate to other academic units within the university if it were not physically present on the same campus. The decision to build the medical school complex at Lake Nona became much easier when it became apparent that other institutions could contribute their efforts to this plan. Most important was a decision by the Burnham Research Institute of California to establish a satellite research laboratory in Florida and an agreement between Burnham and the state that the facility would be located on land adjacent to the site of the new medical school. Following that decision, the Veterans Administration (VA), which had decided to construct a new VA hospital in Orlando (projected completion in 2012), also decided to build on the Lake Nona site, as did the Nemours Health System, which decided to construct a new children s hospital at the site (projected completion in 2013). In the midst of this activity, the university leadership decided to embed the Burnett College of Biomedical Sciences in the medical school as the Burnett School of Biomedical Sciences and to relocate the faculty to a new medical research building (198,000 sq ft) constructed adjacent to a new medical school facility (168,000 sq ft) on the Lake Nona site. Thus, within a few short years, the Lake Nona site will be home to a major new 20 Case Studies Case Studies 21

12 academic medicine center complex, one of only a handful of such sites that have been developed during recent decades. One of the truly remarkable things about the development of the medical school complex at Lake Nona is that it has occurred with relatively little state funding. The land on which the buildings are being constructed was donated, and private gifts accounted for most of the funds used for construction of the new buildings. The only state funds committed to the construction costs were provided by a state program that automatically matches funds on a formula-driven basis for private gifts dedicated to capital construction. The new medical school enrolled its charter class of 40 students in August 2009 in temporary space on the main campus that had been renovated for this purpose. The class that enters in 2010 is expected to be the first to start in the new medical school building on the Lake Nona campus. The school will increase the size of the entering class by 20 students each year until it reaches its projected maximum class size of 120 students. The medical school administration has been in active discussions with the major hospitals in Orlando about the nature of the relationships that should emerge as the medical school develops. The two major healthcare systems in the city Orlando Regional Medical Center and the Florida Hospital System have supported the establishment of the new medical school and have actively sought ways to cooperate as the school has evolved. The medical school currently has an affiliation agreement with Orlando Regional that will provide opportunities for medical students to participate in clinical clerkships during the third and fourth years of their education. The institutions are still in discussions about how the full-time clinical faculty at the hospitals who have been in place for years will relate to the medical school s desire to recruit full-time clinical faculty to staff clinical departments. The medical school has also been discussing with hospital officials the role the school might play in graduate medical education. Orlando Regional has sponsored graduate medical programs in seven specialties (internal medicine, surgery, pediatrics, obstetrics/gynecology, emergency medicine, pathology, and orthopedics). The Florida Hospital System has for many years sponsored a family medicine residency and is starting new programs in internal medicine, surgery, and emergency medicine. The hospitals will continue to sponsor these programs. Programs in neurology and psychiatry are also needed, and discussions are underway about how those should be developed. Texas Tech University Health Sciences Center Paul L. Foster School of Medicine Texas Tech University is a public institution whose main campus is located in the West Texas city of Lubbock. The university offers a large number of undergraduate and graduate degree programs and has an enrollment of greater than 28,000 students. The university is classified as a Research University (high research activity). Texas Tech s involvement with medical education began in 1969 when the Texas legislature granted the university the authority to establish a new medical school. At the time, there was some disagreement among government officials and community leaders about where the new medical school should be located. Although some favored placing the school in Amarillo or El Paso, a decision was ultimately made to locate the school on the university s main campus in Lubbock. To accommodate the interest of other West Texas communities, it was also decided that the medical school would provide clinical clerkship experiences in Amarillo and El Paso. In 1973, third- and fourth-year clinical clerkship rotations were established in El Paso. In 1979, the university constructed a building in El Paso to provide classrooms and faculty offices on land adjacent to the county hospital, where most of the clerkship experiences were provided. As a result, the site was recognized as a Regional Academic Health Center. In the ensuing years, El Paso became the school s main site for clinical education. By the early 1990s, approximately half of the school s students were taking their clerkships in El Paso. As a result, El Paso became a natural location for the development of an independent medical school. In 1996, the Regents of Texas Tech University approved a major change in the organizational structure of the university. The university s health sciences programs, including the medical school, were incorporated into a separate entity the Texas Tech University Health Sciences Center 22 Case Studies Case Studies 23

13 (TTUHSC) thereby creating the Texas Tech University System. Under the reorganization plan, the Texas Tech University and the TTUHSC were to be led by university presidents, while the Texas Tech System was to be led by a chancellor. As soon as the new leadership team was in place, discussions began about establishing a second medical school within TTUHSC. In 1998, the Regents for the System approved the proposal to establish a second medical school within TTUHSC. In 2001, the legislature awarded the system $3 million to study the feasibility of establishing a new medical school in El Paso. That same year, the legislature asked the Texas Higher Education Coordinating Board to study the need for new health professions schools in the state. The Coordinating Board released its report in July The Board had concluded that the state had an inadequate number of practicing physicians and that many communities were underserved, particularly in the western and southern Rio Grande border areas. The Board recommended in their report that the number of students graduating from the state s eight medical schools should be increased, primarily by increasing enrollments in the schools with small student bodies (Texas Tech, Texas A&M, and North Texas State). The Board also recommended that if a new medical school was to be developed in the state it should be located in a region with a documented need for more physicians to improve access to medical care for the region s citizens. In 2003, the legislature approved the establishment of a new medical school in El Paso. Although the legislature did not appropriate the funds required for the school s operation, it did appropriate funds for the construction of a new research building (99,000 sq ft) on land donated for the development of the new medical school. Funds were also provided to add space (43,000 sq ft) to the existing Regional Academic Health Center building. In the next biennial legislative session (2005), the legislature appropriated funds for the construction of a new medical education building (125,000 sq ft) on the site, and in 2007 appropriated the funds required for the school s operation. The school has received a number of private gifts. The largest of the gifts $50 million resulted in the school being named the Paul L. Foster School of Medicine. The school enrolled its charter class of 40 students in July 2009 and plans to increase the size of the entering class by 20 students each year until it reaches the maximum projected class size of 100 students. The school s research effort will focus on issues that primarily affect the health of the populations living on both sides of the border dividing West Texas and Mexico. The university has been quite successful in recent years in acquiring federal funds to support an Office of Border Health. The school will also be actively involved in graduate medical education. These activities will include sponsorship of eight such programs at the school s primary clinical affiliate, the local county hospital, and an additional residency with William Beaumont General Hospital, an army hospital in El Paso that provides clinical education experiences for the school s students. The Commonwealth Medical College of Pennsylvania In 2002, a group of community leaders began to explore the possibility of establishing a medical school in Scranton, Pennsylvania. This group the Northeastern Pennsylvania Medical Education Development Consortium had two main reasons for trying to establish a medical school in the region. First, they hoped that a medical school might result in more physicians establishing practices in the region. This was an important consideration, because on a population basis the region has fewer practicing physicians than the average for the state as a whole, and most of the counties in the region are identified as Health Professions Shortage Areas by the federal government. In addition to the overall shortage of physicians, a disproportionate number of those practicing in the regions were graduates of non-u.s. medical schools. Second, the members of the Consortium hoped that the presence of a new medical school would have a favorable impact on the economy of the region, which had been declining steadily during recent decades, leading to a decline of almost one third of the population of Scranton, one of the largest cities in the region. In 2006, the Consortium received a large grant from the Pennsylvania Department of Health to study the feasibility of establishing a new medical school in Scranton. The consultant report that resulted projected that a new medical school would have a favorable impact on the region s economy, provided that the school was an allopathic school that would pursue the traditional tripartite mission of education, research, and clinical 24 Case Studies Case Studies 25

14 care. Based on those findings, the Consortium decided to begin formal planning for a new medical school in the region. In 2007, the Consortium established the Commonwealth Medical Education Corporation, a 501(c)(3) entity, as the corporate home for the new medical school. This action was taken because the new medical school was to be established as a freestanding institution, rather than being embedded in a sponsoring university. A founding dean was recruited the same year, and plans were developed for the construction of a medical school building (200,000 sq ft) on land purchased in downtown Scranton. The Commonwealth of Pennsylvania awarded a $35 million grant to help defray the construction costs, and Blue Cross of Northeastern Pennsylvania contributed $45 million to the project. Because the school is a private, freestanding institution, its operating costs will be covered primarily by tuition and fee revenue. The school enrolled a charter class of 60 students in August The education program will be conducted initially in renovated facilities rented from Lackawanna College. The school plans to increase its class size to 120 students when the new medical school building is available. In addition to the medical school facility located in downtown Scranton, the school is establishing regional campus sites in Scranton, Wilkes Barre, and Williamsport, which will provide clinical education. Virginia Tech Carilion School of Medicine Virginia Tech University (VTU) is a public institution located in Blacksburg, Virginia. The university offers a large number of undergraduate and graduate degree programs and has an enrollment of more than 30,000 students. The university is classified as a Research University (very high research activity). Although the Edward Via Virginia College of Osteopathic Medicine is located in the university s research park, it is not a part of the university and has a limited relationship with it. The Carilion Clinic, a major healthcare system in southwestern Virginia, has its main administrative offices in Roanoke, approximately 40 miles from Blacksburg. The system, which includes eight hospitals located throughout the region, employs approximately 500 physicians. The main hospital Carilion Roanoke Memorial Hospital has served for years as a regional clinical campus site for the University of Virginia (UVA) School of Medicine. In addition to providing clerkship experiences for third- and fourth-year medical students from UVA, the hospital sponsors a number of graduate medical education programs that provide residency and fellowship training for approximately 170 resident physicians. In June 2006, the Carilion leadership announced that the organization was embarking on a seven-year plan to transform the system into an organization like the Mayo Clinic. One element of the plan was to develop a new medical school that would be identified with the Carilion Clinic. The leadership of both the Clinic and VTU recognized almost immediately that developing the medical school as a partnership would enhance the prestige of the school and add value to both institutions. The Virginia Tech Carilion (VTC) School of Medicine represents an important new model for establishing a medical school. The school is organized as a freestanding, not-for-profit, 501(c)(3) corporate entity that is governed by a Board of Trustees composed of individuals appointed by VTU and the Carilion Clinic. The school is not a component of either the university or the healthcare system; rather, it is the product of a unique partnership agreement between the two institutions. The development of the school in Roanoke also presented an opportunity for the institutions to partner in expanding and enhancing biomedical research in the area. The two institutions had worked together on such an effort when Carilion decided in the early years of the decade to develop the Carilion Biomedical Institute in Roanoke. The Institute was viewed largely as a means of enticing biomedical research companies to move to the area. Although that effort was unsuccessful, it did establish a foundation for the institutions to build on in developing the new medical school and an associated research institute [Virginia Tech Carilion Research Institute (VTCRI)]. The administrative structure and governance of the two entities are different. The VTCRI, although located in Roanoke, is a component of VTU. The VTCRI director reports to the university s Senior Vice President for Research. As noted above, the Virginia Tech Carilion School of Medicine is a freestanding, private entity governed by a Board of Trustees. The chief executive officer of the corporation the dean of the medical school reports directly to the Board of Trustees. Because both Virginia Tech and 26 Case Studies Case Studies 27

15 Carilion contribute in important ways to the school s operations, the dean is required to maintain close lines of communication with the Virginia Tech Provost, the university s chief academic officer, and the Chief Medical Officer of the Carilion Clinic. Faculty based at Virginia Tech will have major teaching responsibilities in the medical school, as will physicians employed by Carilion Clinic. Scientists recruited to the VTCRI will hold appropriate faculty appointments at Virginia Tech and may be involved in teaching medical students. Although the Commonwealth of Virginia indicated during the early planning for the new school that the university would not receive public funds to support the school s operations, the governor and legislature were highly supportive of the school s development. Indeed, the university received a $59 million appropriation for the construction of a building (153,000 sq ft) to house the medical school and research institute on land owned by the Carilion Clinic. Because the medical school is not a component of the university, it will rent the space it occupies in the facility. The school s operations will be funded in part by the tuition and fee revenue generated from enrolled students. Although Virginia Tech cannot use funds appropriated by the Commonwealth for general operations, it can use other revenue sources to support the school. The Carilion Clinic will fund the clinical education experiences provided for students and contribute funds to support the school s general administration. The medical school intends to enroll a charter class of 40 students in August No plans exist to increase the class size over time. The education program provided by the school will emphasize translational and clinical research in a thematic way throughout the four years of the curriculum. To provide students with the opportunity to interact with resident physicians as they rotate through the full range of clerkships, the Clinic is in the process of expanding the graduate medical education programs it sponsors to include emergency medicine and pediatrics. Hofstra University School of Medicine, in partnership with North Shore-Long Island Jewish Health System Hofstra University is a private institution located in Suffolk County on Long Island (Hempstead, New York). The university offers a large number of undergraduate and graduate degree-granting programs and has an enrollment of approximately 8,000 students. The university is classified as a Doctoral/Research University. The leadership of Hofstra University began to consider the possibility of establishing a medical school when a new president was appointed in At that time, two medical schools existed on Long Island. Stony Brook University, a public institution, was home to an allopathic school, and the New York Institute of Technology, a private institution, was home to an osteopathic school. The Hofstra leadership viewed the development of the school as a way to strengthen the university s biological and physical sciences programs while at the same time enhancing the university s academic standing and prestige. In pursuit of the goal, the university s new president met with key leaders of the AAMC in 2002 to gain a perspective on the challenges of starting a new school. Based on the advice received at the time, a decision was made not to proceed with a formal planning process. However, when the AAMC issued a policy statement in 2006 indicating that enrollment in medical schools should be increased by 30 percent, the university decided to explore once again the possibility of establishing a new medical school. Knowing that the leadership of North Shore Long Island Jewish Health System (North Shore LIJ) had an interest in establishing a medical school, the university president approached the president and CEO of the health system to discuss the possibility of collaborating in the development of a new school. North Shore LIJ, headquartered in Great Neck, Long Island, is one of the country s largest healthcare systems. The system was formed in 1997 by the merger of North Shore Health System and Long Island Jewish Medical Center. It includes three tertiary care hospitals (North Shore University Hospital, Long Island Jewish Medical Center, and the Staten Island University Hospital), two specialty hospitals (Schneider Children s 28 Case Studies Case Studies 29

16 Hospital and The Zucker Hillside Hospital, a psychiatric facility), eight community hospitals, and five long-term care facilities. The system employs more than 10,000 nurses and has a total workforce of more than 38,000 employees. The system serves over five million people living on Long Island, Queens, and Staten Island. The system provides opportunities for clinical education for medical students enrolled in one of five medical schools based in the greater New York City area. It also supports one of the largest graduate medical education programs in the country and sponsors more than 60 residency and fellowship programs that provide clinical training for more than 1,200 residents. In addition to the clinical education programs it supports, the system includes a major research institute The Feinstein Institute for Medical Research, a 501(c)(3) organization. The Institute has made a special commitment to the conduct of translational and clinical research with the opening of a new 55,000-square foot research building. At present, the institute receives more research funding from the National Institutes of Health than almost one third of the country s medical schools. The Institute is also home to the North Shore LIJ Graduate School of Molecular Medicine, the Elmezzi Graduate School, which is accredited by the New York State Board of Regents and the Commissioner of Education to grant a doctoral degree. The school grants Ph.D.s to medical school graduates who have decided to pursue a career in biomedical research. Given the scope of its education and research programs, it is not surprising that the leadership of the healthcare system was receptive to the idea of collaborating with Hofstra in the development of a new medical school. Each of the two institutions that merged to form North Shore LIJ have a long history of involvement in medical education. Shortly after the Long Island Jewish Hospital opened in 1954, it established an academic affiliation with Downstate Medical School and subsequently entered into affiliation agreements with SUNY Stony Brook and Albert Einstein College of Medicine. North Shore Hospital, which opened in 1954, became a major affiliate of Cornell School of Medicine in 1969 and began at that time to develop a range of academic programs. In 1973, it changed its name to North Shore University Hospital to indicate its commitment to education and research. Each of the hospitals has a history of trying to develop a more encompassing affiliation agreement with a medical school, rather than serving as one of the sites used for student clinical rotations. In the 1980s, North Shore University Hospital negotiated with Cornell about the possibility of creating a Cornell satellite campus on property adjacent to the North Shore campus. Long Island Jewish Hospital attempted to become a campus of Albert Einstein College of Medicine during its early years of development in the 1950s and1960s. When that failed to materialize, the hospital hoped to play a role in the development of a new medical school in Queens. The Queens Medical School proposal that surfaced in the 1970s was an outgrowth of numerous efforts to gain approval from the state legislature for the development of a public medical school in Queens. In 1976, a Temporary State Commission established by the legislature to study the need for a medical school in Queens recommended that a Queens Medical School Development Corporation be established to develop the plans for a new school. Despite considerable support for the initiative within state government, the project was abandoned in the mid-1980s. In October 2007, the President of the university and the President and Chief Executive of North Shore LIJ jointly announced plans to establish a new medical school. The nature of the partnership between Hofstra and the healthcare system has been a subject of discussion and negotiation ever since the institutions reached an agreement to proceed with the development of the new school. The institutions considered the possibility of establishing the school as a 501(c)(3) organization, but in the end they rejected that approach. North Shore LIJ has committed to fund the costs of the clinical education experiences and to contribute to the school s administrative and operating costs. An oversight board with representatives from both institutions has been appointed, and the dean of the medical school will also serve as the Chief Medical Officer for the system. The school s name acknowledges that the system is a full partner in the school, not just a clinical affiliate. North Shore LIJ was clearly motivated to be an active partner in the development of the new medical school. The leadership recognized that the existence of the school would enhance the system s brand name and bring it recognition as one of the top healthcare systems in the country. In addition, the leadership envisions that the medical school will provide an impetus for changing how doctors are being educated in ways that will affect how medicine is being practiced. This concept is consistent with the system s commitment to enhance the education of its entire workforce, 30 Case Studies Case Studies 31

17 as evidenced by the development in 2002 of the Center of Learning and Innovation (CLI). The CLI represents the system s effort to create a corporate university that offers an array of educational programs for its employees that will help them to develop and maintain the skill set needed to manage change in the workforce environment and to advance their own careers. In pursuit of that goal, the CLI has partnership arrangements with corporations and a number of universities that are in a position to contribute to specific educational programs. Included in the portfolio of programs are an Institute for Nursing and a Physician Leadership Institute. The development of a new medical school is consistent with the thinking that led to the development of CLI. The leadership of the hospital system and the university intend to establish a nursing school in the near future. The faculty needs to establish that the medical school is largely in place due to the nursing education programs that have been offered to employed nurses by the Institute. The school plans to enroll a charter class of 40 students in August The education program will be held in renovated space in a building formerly used as a training facility by the New York Jets professional football team. The amount of space being renovated is adequate to accommodate the projected class of 100 students. Nevertheless, plans to construct a new medical school facility and student housing are underway. The facilities will also provide space to house a new nursing school. Oakland University William Beaumont School of Medicine Oakland University is a public institution located near Detroit in Rochester, Michigan. The university began as a branch campus of Michigan State University in the late 1950s, and was granted autonomy by the state legislature in The university offers a large number of undergraduate and graduate degree programs, and has an enrollment of approximately 18,000 students. The university has a longstanding commitment to the development of strong biomedical and health professions education programs. During the 1980s, the university established a Health Sciences School, a School of Nursing, and an Institute of Biotechnology. In the 1990s, it added a Center for Biomedical Research and an Executive Management Program in Health Care. Throughout the years, the university has collaborated with the William Beaumont Hospital in nearby Royal Oak on a number of biomedical research projects. The institution is classified as a Doctoral/Research University. William Beaumont Hospital is the largest private teaching healthcare system in the country. The main hospital in Royal Oak, which has over 1,000 beds, ranks first in the country in the number of inpatient admissions and second in the number of surgeries. The healthcare system includes three hospitals in communities north of Detroit (Royal Oak, Troy, and Gross Pointe), as well as numerous community-based medical centers, nursing homes, and an assisted living facility. Beaumont is also a major academic medical center. The hospital sponsors 37 graduate medical education programs that provide training for over 400 resident physicians. It is also a site for required and elective clinical clerkship experiences for students enrolled in the medical schools of the University of Michigan and Wayne State University, as well as a number of out-of-state schools. Its research component, the Beaumont Research Institute, has over 300 investigators on staff. In early 2000, Michigan State University College of Osteopathic Medicine (MSUCOM) approached Oakland University about the possibility of becoming a branch campus of the college. Such an arrangement would have resulted in approximately 100 MSUCOM students taking the first two years of the college s curriculum on the Oakland campus. Although the two institutions were unable to come to an agreement, the discussions did lead the university to consider the possibility of establishing an entirely new osteopathic medical school on the campus. To that end, the university leadership had a preliminary discussion with the leadership of William Beaumont about the possibility of collaborating in the venture. Beaumont s leadership had little interest in becoming involved. Moreover, a number of representatives from the academic medicine community urged the university to consider the possibility of developing a new allopathic medical school if their intent was to create a medical school presence within the university. In 2006, the university leadership approached the leadership of William Beaumont again, this time to explore whether Beaumont would be interested in partnering with Oakland in the development of a new allopathic school. 32 Case Studies Case Studies 33

18 The leadership at Beaumont was receptive to the idea because they had become interested in recent years in establishing the Institute as a major affiliate of a medical school. Given the size and scope of the institution s academic programs, the hospital did not want to continue to serve as a site for a large number of elective experiences for students from a number of different medical schools. To some degree, the hospital s interest evolved out of discussions with the leadership of the Wayne State University School of Medicine about becoming a major affiliate of the medical school. Wayne State s leadership initiated the discussion out of a concern about the viability of the school s longstanding affiliation relationship with the Detroit Medical Center. The discussions led to an agreement that Beaumont would serve as the site for required clinical experiences for 25 third-year Wayne State students, but did not go beyond that. Accordingly, the Beaumont leadership was receptive when approached by Oakland about the possibility of working together to establish a new medical school. Given Beaumont s interest, the two institutions entered into serious discussions about how to proceed. As the two institutions began their discussions, the major challenge they faced was to determine how to structure the relationship in a way that would ensure that both institutions were equal partners in the governance, financing, and administration of the new school. The institutions considered a number of options, including the possibility of establishing the school as a separate 501(c)(3) corporate entity. Although this model was recognized as the one most likely to ensure that the two institutions would function as equal partners, it was ultimately deemed unworkable because it would have precluded Oakland from using any of its stateappropriated operating funds in support of what would have been a private school. Under the agreement that was ultimately reached, Beaumont assumed responsibility for funding the school s clinical education program and agreed to share in the support of the school s administrative costs. In return, Beaumont was granted an exclusive affiliation agreement, and its name was incorporated into the name of the medical school. The schools also agreed that the medical school dean would serve as Beaumont s Chief Academic Officer. A steering committee composed of leaders from both institutions was established to ensure that the terms of the partnership agreement would be honored by both institutions. Thus, in October 2007, the Oakland University President and the William Beaumont President and CEO jointly announced plans to establish a new medical school. Oakland University faces two important challenges as it proceeds with planning for the development of the school: 1) how to fund the operating costs for the first two years of the curriculum, as well as its share of the school s administrative costs; and 2) how to meet the school s administrative and instructional space needs. Unlike the situation in other states, such as Florida, Texas, and California, the public universities in Michigan do not need approval from a higher education body or the state legislature before establishing a new medical school, nor do they need to obtain targeted state appropriations to do so. Thus, Oakland is free to reallocate from funds for existing resources to support the new school. However, given the state of the Michigan economy and the effect this economic downturn is having on funding of higher education, it will be a challenge for the university to reallocate funds currently committed to the support of existing academic programs. The university originally intended that it would enroll the medical school s charter class of 50 students in late summer Current plans call for the charter class to begin studies in The university is remodeling a building on campus that will be adequate to accommodate a projected class of 125 students for an indefinite period. A new facility is planned, to be constructed at a research park site on campus. A new building for a nursing school and other health professions education programs is under construction. Projected completion of the new medical school facility is University of California, Riverside, School of Medicine University of California, Riverside (UCR) is one of ten campuses within the University of California System. The campus is located about 50 miles east of Los Angeles in an area of the state referred to as the Inland Empire. The campus offers a large number of undergraduate and graduate degree programs and has an enrollment of more than 18,000 students. The university is classified as a Research University (very high research activity). 34 Case Studies Case Studies 35

19 In March 2008, UCR submitted a formal proposal to the Office of the UC President for establishing a new medical school on the UCR campus. The UCR request was a direct outgrowth of health professions planning activities initiated by the UC President in 2003, including plans for a study to determine the adequacy of the health professions workforce serving the citizens of the state. This mandate has a historical basis in the adoption in 1960 of the State of California Master Plan for higher education, which granted the UC System exclusive jurisdiction over the granting of the M.D. degree. As a result, all of the public medical schools in the state are on campuses that are components of the UC System. Although the state legislature has absolute authority for deciding whether to fund a new medical school within the system, the UC Board of Regents has the authority to decide on which campus a new medical school might be established. In response to the President s directive, the Office of Health Affairs charged a newly established subcommittee (University-Wide Health Sciences Committee) of the Academic Planning Council to conduct the analysis requested. The committee s report (Workforce Needs and Enrollment Planning) was issued in June The committee concluded that there would be a shortage of 17,000 physicians in the state by To address that shortfall, they recommended that by 2012 the university should increase the number of students graduating from the system s medical schools. They also recommended that planning should begin for the development of one or two new schools, and that the schools should be located in underserved regions of the state, primarily the Inland Empire and the Central Valley. Following the release of the report, the Office of Health Affairs appointed the Advisory Council on Future Growth in the Health Professions to make recommendations for how the university should respond to the study s findings. The council issued its final report (A Compelling Case for Growth) in January They recommended that medical school enrollments be increased by 34 percent by 2020, primarily by incrementally increasing the class sizes of the system s existing medical schools. At the same time, the council recommended that one new medical school should be established within a timeframe that would result in the school graduating its first class by Given UCR s location in the Inland Empire and its longstanding involvement in medical education, it is not surprising that the Regents decided in March 2008 to approve the UCR request that it be allowed to establish a new medical school. UCR s involvement with medical education began in the early 1970s. At that time, the Riverside Chancellor decided to explore the possibility of establishing a medical education program on the campus in conjunction with UCLA School of Medicine. The Chancellor sought a relationship with UCLA because he believed that the existence of a medical education program on the UCR campus would increase the likelihood of recruiting high-quality students to the campus as undergraduates and would also enhance the university s biological sciences programs. This discussion led to a plan for a seven-year B.S.-M.D. Biomedical Sciences Program so that students could complete three years of undergraduate study and the first two years of the UCLA medical school curriculum at UCR. The students who successfully completed that course of study then transferred to the UCLA campus to complete the last two years of the medical school curriculum. The students who participated in the program received their B.S. degree from UCR after completing the first year of the medical school curriculum and then received their M.D. degree from UCLA upon completion of the curriculum. The first group of students enrolled in the program as undergraduates in Each year approximately 200 to 250 entering freshmen students enrolled in the program. However, only 24 of these enrolled students could be accepted into the UCLA medical school component. Students enrolled as undergraduates at other UC campuses, or enrolled at UCR as undergraduates in other degree-granting programs, were not eligible to apply for the UCLA medical school positions offered on the UCR campus. Due to the limited number of positions available, competition for the medical school positions offered at UCR was intense. Indeed, the quality of the students who entered the medical school by participating in the program became apparent when their results on national board examinations became known. The students who participated in the Biomedical Sciences Program performed better on both Part 1 and Part 2 of the examination sequence than did students admitted to the UCLA medical school through the standard application process. As originally designed, the program was to provide the first two years of the UCLA medical school curriculum on the UCR campus, with the 36 Case Studies Case Studies 37

20 clinical experiences in the second year provided at a local county hospital (San Bernardino County Medical Center) that had an academic affiliation agreement with UCLA. When that affiliation agreement was terminated in 1982, the second year of the medical school curriculum was transferred from the UCR campus to UCLA so that the students could participate in clinical education at Harbor UCLA Hospital. Thus, during the period from 1982 to 1997, the Biomedical Sciences Program based at UCR was only four years in duration. The second year of the medical school program was re-established at UCR in At that time, the program was renamed the Thomas Haider Program in Biomedical Sciences at UCR. In 1999, the program, which up to that time had been embedded in the College of Natural and Agricultural Sciences, became an independent academic unit. During the same period, various interest groups began to criticize the program for the way it was organized and conducted. Some of the criticism related to the fact that students enrolled in other majors at UCR, or as undergraduates at other campuses, were not eligible to compete for the medical school positions offered at UCR. Others expressed concern about the large number of students who enrolled in the program as undergraduates and then were unable to complete the program because of the limited number of medical school positions available. Another concern was that the intense competition for the medical school positions meant that minority students were underrepresented in the medical school phase of the program. These criticisms ultimately led to fundamental changes in the program. A plan for restructuring the program was presented to the Chancellor in As a result of the restructuring, the undergraduate phase of the program was eliminated. The program was converted to one in which the first two years of the UCLA medical school curriculum continued to be conducted on the UCR campus. Although admission to the program continued to be limited to UCR undergraduates, any student, regardless of his or her major, could apply for entry into the medical school. planning should begin for establishing a new medical school in the Inland Empire, UCR proposed to the University officials that the new medical school should be at UCR, and they were granted approval to plan for the new school in November When they granted approval in 2008 for the establishment of a new UCR medical school, the Regents placed significant constraints on how the campus could fund the development of the school due to the economic climate in the state. Consequently, UCR has not yet applied to the LCME to begin the accreditation process required before they can recruit and enroll a charter class. However, the campus has begun recruitment of a founding dean. The projected start date for the charter class is UCR officials are reasonably confident that they will be able to acquire from a variety of sources the funds required to support the pre-enrollment planning activities. UCR plans to provide and renovate additional space in the building where the current UCLA medical students are housed in order to accommodate the projected size of the charter class (50 students). The school will ultimately increase the size of the entering class to 100 students once a new and larger medical school facility has been constructed on the campus. UCR also plans to construct a new health sciences research building using funds that may become available as a result of the federal economic stimulus package. UCR has also begun working with healthcare organizations in the region to develop new graduate medical education programs. The new medical school will serve as the institutional sponsor for these programs and provide financial support for the institutional and program level administration required. Coincident with the planning process that led to the changes in the Haider Program, UCR officials began planning for the possible development of an independent medical school. Thus, when the Universitywide Health Sciences Committee issued its report in June 2005 recommending that 38 Case Studies Case Studies 39

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